Objective: We aimed to investigate the efficacy of Holmium-YAG (Ho-YAG) laser used via video-assisted thoracoscopic surgery and compare it with the talc slurry pleurodesis in patients with malignant pleural effusion (MPE).

Methods: A total of 51 subjects with MPE were included. Patients were divided into two groups. In the laser group, pleurodesis was attempted with Holmium-YAG laser via uniportal video-thoracoscopy (VATS) in 30 subjects, and in the talc group, pleurodesis was attempted with talc slurry via a small bore chest tube in 21 subjects. The success rate of pleurodesis was evaluated by chest X-ray and/or thorax computed tomography obtained at the second month following pleurodesis and was graded as total success, partial success, or failure.

Results: In the laser group, the success rates of pleurodesis were total success in 19 (63%) patients and partial in 7 (23%) patients. The volume of pleural effusion drained postoperatively was significantly different between success subgroups (total success subgroup vs. failure subgroup p=0.000, partial success subgroup vs. failure subgroup p=0.001). In the talc group, the success rates of pleurodesis were total success in 11 (52 %) patients and partial in 6 (29 %) patients. Comparison of success rates of pleurodesis between talc and laser groups showed no significant difference (p=0.725).

Conclusion: We concluded that Holmium-YAG laser performed via video-thoracoscopy is a safe and effective option for pleurodesis in the management of MPE. However, there is no difference between Holmium-YAG laser and talk slurry pleurodesis in terms of procedure success rates.